Nándor Szegedi

ECG summary
Steps of ECG analysis

• Heart rate
• P wave, rhythm
• PR interval
• QRS, axis
• ST-T segment
• QT interval
Steps of ECG analysis - simplified

• Rhythm, heart rate

• QRS
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• ST-T, QT
RHYTHM, HEART RATE
Heart rate (HR)

1 big square 0.2 sec

300 big squares 60 sec

Heart rate: Loading…

• How many QRS is in 300 big squares (60
sec)?
• HR = 300 / (number of big squares
between the QRS-es)
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Atrial flutter with impaired AV-conduction (regular R-R interval)
Atrial flutter with impaired AV-conduction (irregular R-R interval)
Atrial flutter with right bundle branch block and left anterior fascicular block
Fast broad
irregular
tachycardia

(=preexcited
atrial fibrillation)
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AVNRT
AVNRT
AVRT
AVRT
QRS width, morphology
Left fascicular
blocks
• Left anterior • Left posterior
fascicular block fascicular block
(LAFB) (LPFB)
Bundle branch blocks - LBBB
• PR normal / long
• QRS morphology: positive in lead I, negative in lead V1
• The second half of the QRS is wider than the first half
Bundle branch blocks - RBBB
 artefacts

• PR normal / long
• QRS morphology: shallow and wide S-wave in lead I; positive in lead
V1
• The second half of the QRS is wider than the first half
• Is often associated with LAFB / LPFB, and prolonged PR interval
• PR interval is short
• The first half of the QRS is wider than the second half (because of the
preexcitation)
Accelerated idioventricular rhythm
Ventricular tachycardia
ST-T segment, QT interval
 ST-elevation
Potential causes: Localization:
• Secunder repolarization
abnormality (LBBB, WPW-sy.) • Inferior: II, III, aVF
• STEMI • Septal: V1-V2
• Pericarditis • Anterior: V3-V4
• Myocarditis • Apical (-lateral): V5-V6
• Prinzmetal angina • Lateral: I, aVL
• Left ventricular aneurysm • Extensive anterior: V1-V6, I,
• Brugada-sy. aVL
• Hypothermia
• Early repolarization
• Tako-tsubo cardiomyopathia
QT interval: If the end of T-wave does not reach beyond the half of the R-R
distance, the QT is likely not long (of course you need to calculate the QTc value)
Thank you for your attention!